Analysis of influencing factors for postoperative venous thromboembolism of inguinal hernia / 中华消化外科杂志

ABSTRACT

Objective:To investigate the influencing factors for postoperative venous thromboembolism (VTE) of inguinal hernia.Methods:The retrospective case-control study was conducted. The clinical data of 350 patients undergoing surgical treatment of inguinal hernia who were admitted to Affiliated Hospital of Zunyi Medical University from January to December 2017 were collected. There were 287 males and 63 females, aged from 15 to 89 years, with a median age of 57 years. Observation indicators (1) surgical and postoperative situations; (2) follow-up; (3) analysis of influencing factors for postoperative VTE of inguinal hernia. Follow-up using outpatient examination and telephone interview was performed to detect recurrence and complications of inguinal hernia after patients being discharged from hospital. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the nonparametric rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Multivariate analysis was conducted using the binary Logistic regression model. Results:(1) Surgical and postoperative situations of the 350 patients, 173 underwent open inguinal hernia surgery including 66 cases with plain patch repair, 54 cases with Lichtenstein repair, 30 cases with mesh plug plain patch repair, 23 cases with Bassini repair, and 177 underwent laparoscopic inguinal hernia surgery including 134 cases with laparoscopic transabdominal preperitoneal prothetic repair, 43 cases with laparoscopic totally extraperitoneal prothetic repair. There were 335 of the 350 patients negative for postoperative VTE while 15 patients positive for postoperative VTE. Of the 15 patients who were diagnosed with postoperative VTE, 13 cases underwent open surgery while 2 cases underwent laparoscopic surgery including 1 died; 12 cases were diagnosed with deep vein thrombosis and 3 cases were diagnosed with pulmonary thromboembolism including 1 died. (2) Follow-up 349 of the 350 patients were followed up for one year after operation. Of the 349 patients, 2 had recurrence of inguinal hernia and 18 had seroma in the operation area within one year. None of the 349 patients had postoperative patch-related infection or incision infection in the operation area. Of the 14 patients who were diagnosed with postoperative VTE, recurrence of inguinal hernia was not observed within one year. (3) Analysis of influencing factors for VTE of inguinal hernia. Results of univariate showed that age, body mass index (BMI), hypertension, type of operation, the compression time of operative area, time to first out-of-bed activities, duration of hospital stay, postoperative Caprini score were influencing factors for postoperative VTE of inguinal hernia ( χ2=13.217, 9.183, 4.388, 8.694, Z=-4.690, -5.265, -4.281, -4.883, P<0.05), and age, cases with chronic bronchitis, the stable stage of chronic obstructive pulmonary disease (COPD) were influencing factors for postoperative VTE of inguinal hernia ( P<0.05). Results of multivariate analysis showed that age≥65 years, BMI≥25.0 kg/m 2, chronic bronchitis, the stable stage of COPD, open surgery, the compression time of operative area≥42 hours, time to first out-of-bed activities≥60 hours, postoperative Caprini score>5 were independent risk factors for postoperative VTE of inguinal hernia ( odds ratio=1.085, 1.320, 0.256, 0.013, 7.874, 1.112, 1.027, 6.909, 95% confidence interval 1.031-1.141, 1.024-1.702, 0.071-0.929, 0.016-0.800, 1.489-41.630, 1.061-1.165, 1.008-1.047, 3.045-15.678, P<0.05). Conclusions:Age≥65 years, BMI≥25.0 kg/m 2, cases with chronic bronchitis preoperatively, the stable stage of COPD, open surgery, the compression time of operative area≥42 hours, time to first out-of-bed activities≥60 hours, postoperative Caprini score>5 are independent risk factors for postoperative VTE of inguinal hernia.